scholarly journals The Relevance of Insulin-Like Growth Factor-1 and Insulin-Like Growth FactorBinding Protein-3 Concentrations as a Screening Test for Diagnosis of Growth Hormone Deficiency

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Growth Hormone Deficiency ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Reference Range ◽  
Hormone Deficiency ◽  
Age And Sex ◽  
Igfbp 3

Background and objective: Growth hormone deficiency (GHD) is one of the most important endocrine and treatable causes of short stature. Reports regarding the sensitivity and specificity of insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 (IGFBP-3) are not consistent. The aim of our study was to analyze the relevance of IGF-1 and IGFBP-3 concentrations as a screening test for diagnosis of GHD. Design: We retrospectively studied 40 patients whom were evaluated for short stature at the Endocrinology Department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia between January 2015 to December 2018. For IGF-1 and IGFBP-3 concentrations, laboratory reference ranges were based on age and sex. For all eligible patients, IGF-1 and IGFBP-3 concentrations were determined and an insulin tolerance test (ITT) was performed. Patients with a peak GH of ≤5.0 ng/ml were considered to be GHD. Results: We retrospectively included 40 patients evaluated for SS for analysis. Mean age was 14.7 ±1.7 years. There were 38 males (80.9%) and 9 females (19.1%) and mean IGF-1 concentration was 146.4 ±69.4 ng/dl. The observed male to female ratio was 4.2:1. Results from the ITT indicated that 27 (57.4%) had GHD. Age was not statistically significant different between GHD (14.7 ±1.8 years) and non-GHD (14.8 ±1.6 years), p=0.9. Moreover, there was non statistical significant more males (59%) than females (50%) in the GHD patients, P=0.7. In addition, there were not statistically significantly different between GHD and non-GHD patients in mean IGF-1 concentration (156.0 ±71.1 ng/dl vs. 140.8 ±68.1 ng/dl, p=0.5) and IGFBP-3 concentration (3752.9 ±1295.9mcg/L vs. 3816.8 ±867.0mcg/L, p=0.9). The mean peak for GH concentration was significantly lower in patients with GHD than without GHD (2.2 ±1.3 ng/ml vs. 9.9 ±5.6 ng/ml, p<0.0001). Peak GH concentration was not significantly positively correlated with IGF-1 concentration (r=0.181, P=0.3) and IGFBP-3 concentration (r=0.103, P=0.5). With a threshold of IGF-1 concentration, sensitivity was 48% (95% confidence interval (95%CI); 26%, 70%), specificity was 37% (95%CI; 16%, 62%) and the negative predictive value for the diagnosis of GHD was 39% (95% CI; 24%, 57%). With a threshold of IGF-1+IGFBP-3 concentration, the sensitivity was 19% (95% CI; 5%, 42%) and the specificity was 89% (95%CI; 67%, 99%). A positive predictive value of 67% (95% CI; 29%, 91%) but a negative predictive value of 50% (95%CI; 44%, 56%). 17 of the patients with IGF-1+IGFBP-3 concentration above the threshold (N = 34) were normal and 17 had GH deficiency. These 17 GHD patients had IGF-1+IGFBP-3 concentration below the reference range for age and sex that did not differ significantly from those of their GH-sufficient counterparts (66.7% vs 50% , P=0.7) respectively. If IGF1+IGFBP-3 concentration was used as a screening test (with a concentration threshold below the reference range for age and sex) and ITT as a confirmatory test, 34 (85%) out of 40 ITT would not have been performed, leading to the misdiagnosis of 17 GH-deficient adults. Thus, in our study population, such a procedure would misdiagnose 17 out of 21 GHD patients (81%) and yield a sensitivity of 19%. Conclusion: Our study demonstrated the good negative predictive value of IGF-1+IGFBP-3 concentration for the diagnosis of GHD, making it possible to minimize the use of the “reference test” method ITT. This observation remains to be validated by population-based studies.

scholarly journals The Relevance of Insulin-like Growth Factor-1 Concentration as a Screening Test for Diagnosis of Growth Hormone Deficiency

2019 ◽  
Vol 1 (1) ◽  
pp. 16-23
Author(s):  
Khalid S Aljabri ◽  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Hormone Deficiency ◽  
Reference Ranges ◽  
Insulin Like Growth Factor

Objective: Growth hormone deficiency (GHD) is one of the most important endocrine and treatable causes of short stature. Insulin-like growth factor 1 (IGF-1) concentration is not recommended to establish the diagnosis of GHD. The aim of our study was to analyze the relevance of IGF-1 concentration as a screening test for the diagnosis of GHD. Materials and Methods: We retrospectively studied patients who were evaluated for short stature at the Endocrinology Department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia from January 2015 to December 2018. For IGF-1, laboratory reference ranges were based on age and sex. For all eligible patients, IGF-1 concentration was determined and an ITT was performed. Patients with a peak GH of ≤ 5.0 ng/ml were considered to be GHD and patients with a peak GH of ≥ 5.1 ng/ml were considered non-GHD (nGHD). Results: We retrospectively included 47 patients for analysis. Mean age was 14.7 ± 1.7 years. There were 38 males (80.9%) and 9 females (19.1%) and mean IGF-1 concentration was 146.4 ± 69.4 ng/dl. Results from the ITT indicated that 27 (57.4%) had GHD. Age was not significantly different between GHD and non-GHD (14.7 ± 1.8 vs. 14.8 ± 1.6 years, P = 0.9). There were non-significantly more males than females in GHD patients (59% vs. 50%, P = 0.7). Mean IGF-1 concentration was not significantly different (146.9 ± 70.4 ng/dl vs. 145.7 ± 69.8 ng/dl, P = 0.9). IGF-1 concentration below the reference ranges for age and gender was non-significantly higher in patients with GHD compared to non-GHD (53.8% vs. 46.2%, P = 0.8). The mean peak for GH concentration was significantly lower in patients with GHD (2.2 ± 1.3 ng/ml vs. 9.9 ± 5.6 ng/ml, P < 0.0001). Peak GH concentration was not significantly correlated with IGF-1 concentration (r = 0.213, P = 0.2). We plotted a ROC curve of IGF-1 concentration according to the diagnosis of GHD as established using ITT. The AUC was 49%. An IGF-1 threshold of 154 ng/dl was selected to emphasize sensitivity rather than specificity. With a threshold of 154 ng/dl, sensitivity was 52% (95% confidence interval (95% CI); 32%, 71%), specificity was 40% (95% CI; 19%, 64%) and the negative predictive value for the diagnosis of GHD was 38% (95% CI; 24%, 54%). With a threshold of 105 ng/dl, the sensitivity was 41% and the specificity was 70%. A threshold of 74 ng/dl, gave a positive predictive value of 60% but a negative predictive value of 43%. 7 of the patients with IGF-1 concentration above the threshold of 154 ng/dl (N = 20) were normal and 13 had GH deficiency. These 13 GHD patients had IGF-1 concentration that differs significantly from those of their GH-sufficient counterparts (105 ± 35 vs. 222 ± 49 ng/dl, P < 0.0001). If IGF-1 was used as a screening test (with a concentration threshold of 154 ng/dl) and ITT as a confirmatory test, 20 (43%) out of 47 ITT would not have been performed, leading to the misdiagnosis of 13 GH-deficient adults. Thus, in our study population, such a procedure would misdiagnose 13 out of 27 GHD patients (48%) and yield a sensitivity of 52%. Conclusion: Many reports have already reported that IGF-1 concentration is lower in patients with GHD than in the general population, our study demonstrated the poor negative predictive value of IGF-1 concentration for the diagnosis of GHD, making it the need of the use of the “gold standard” method ITT. This observation remains to be validated by population-based studies.

scholarly journals Insulin-like growth factor-1 level is a poor diagnostic indicator of growth hormone deficiency

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hideyuki Iwayama ◽  
Sachiko Kitagawa ◽  
Jyun Sada ◽  
Ryosuke Miyamoto ◽  
Tomohito Hayakawa ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Diagnostic Accuracy ◽  
Growth Hormone Deficiency ◽  
Screening Test ◽  
Characteristic Curve ◽  
Hormone Deficiency ◽  
Height Velocity ◽  
Insulin Like Growth Factor ◽  
Predictive Values

AbstractWe evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Among 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 standard deviation (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of − 1.493 SD, with 0.685 sensitivity, 0.417 specificity, 0.25 positive and 0.823 negative predictive values, and 0.517 area under the curve. Correlation analysis revealed that none of the items of patients’ characteristics increased the diagnostic power of IGF-1. IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Therefore, IGF-1 should not be used alone for GHD screening. A predictive biomarker for GHD should be developed in the future.

Diagnostic accuracy of IGF-1 for screening growth hormone deficiency: a prospective, single-center, diagnostic accuracy study

2021 ◽  
Author(s):  
Hideyuki Iwayama ◽  
Sachiko Kitagawa ◽  
Jyun Sada ◽  
Ryosuke Miyamoto ◽  
Tomohito Hayakawa ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Diagnostic Accuracy ◽  
Growth Hormone Deficiency ◽  
Predictive Value ◽  
Screening Test ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Hormone Deficiency ◽  
Height Velocity

Abstract Purpose We evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Methods On 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. Results We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of −1.493 SD, with sensitivity of 0.685, specificity of 0.417, positive predictive value of 0.25, negative predictive value of 0.823, and area under the curve of 0.517. Spearman’s rank correlation coefficient showed that IGF-1 (SD) was weakly correlated with age, bone age, height velocity before examination, weight (SD), and BMI (SD) and very weakly correlated with height (SD), target height (SD), and maximum GH peak. Conclusion IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Correlation analysis revealed that none of the items increased the diagnostic power of IGF-1. Therefore, IGF-1 should not be used alone in the screening of GHD. A predictive biomarker for GHD should be developed in the future.

scholarly journals Diagnostic accuracy of insulin-like growth factor-1 for screening growth hormone deficiency: a prospective, single-center, diagnostic accuracy study

2021 ◽  
Author(s):  
Hideyuki Iwayama ◽  
Sachiko Kitagawa ◽  
Jyun Sada ◽  
Ryosuke Miyamoto ◽  
Tomohito Hayakawa ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Diagnostic Accuracy ◽  
Growth Hormone Deficiency ◽  
Screening Test ◽  
Characteristic Curve ◽  
Hormone Deficiency ◽  
Height Velocity ◽  
Insulin Like Growth Factor ◽  
Predictive Values

Abstract Purpose We evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Methods Among 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. Results We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of −1.493 SD, with 0.685 sensitivity, 0.417 specificity, 0.25 positive and 0.823 negative predictive values, and 0.517 area under the curve. Correlation analysis revealed that none of the items of patients’ characteristics increased the diagnostic power of IGF-1. Conclusion IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Therefore, IGF-1 should not be used alone in the screening of GHD. A predictive biomarker for GHD should be developed in the future.

scholarly journals Usefulness and Limitation of Measurement of Insulin-Like Growth Factor Binding Protein-3(IGFBP-3) for Diagnosis of Growth Hormone Deficiency.

1992 ◽  
Vol 39 (6) ◽  
pp. 585-591 ◽  
Author(s):  
YUKIHIRO HASEGAWA ◽  
TOMONOBU HASEGAWA ◽  
TAIJI ASO ◽  
SHINOBU KOTOH ◽  
YUTAKA TSUCHIYA ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Growth Hormone Deficiency ◽  
Binding Protein ◽  
Hormone Deficiency ◽  
Insulin Like Growth Factor ◽  
Factor Binding ◽  
Igfbp 3

scholarly journals Comparison Between Insulin-Like Growth Factor-I(IGF-I) and IGF Binding Protein-3(IGFBP-3) Measurement in the Diagnosis of Growth Hormone Deficiency.

1993 ◽  
Vol 40 (2) ◽  
pp. 185-190 ◽  
Author(s):  
YUKIHIRO HASEGAWA ◽  
TOMONOBU HASEGAWA ◽  
TAIJI ASO ◽  
SHINOBU KOTOH ◽  
YUTAKA TSUCHIYA ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Growth Hormone Deficiency ◽  
Hormone Deficiency ◽  
Insulin Like Growth Factor ◽  
Factor I ◽  
Igf I ◽  
Igf Binding ◽  
Igf Binding Protein ◽  
Igfbp 3
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